La

wail

- mi-
Mitral Commissural View
Fig. 42. Transgastric long axis (J).

Transgastric long axis

Ao

Transgastric right ventricular inflow

(40 -45cm) Multiplane

120; angle range

Right Ventricular Pressure Wave
Fig. 44. Transgastric right ventricular inflow (N).

Transgastric RV inflow

Tee Four Chamber View Inferior WallDeep Transgastric Tee
Fig. 46. Deep transgastric long axis (K). (Please see companion DVD for corresponding video.)

Deep transgastric long axis

Commisural View

ORDER OF EXAMINATION: STAGE 1

ME level: multiplane from 0 to approx 120°.

ME four-chamber (A): Figs. 8-10 (please see companion DVD for corresponding video for Figs. 8 and 10).

• Inferior septum and lateral wall of left ventricle (LV).

• Right ventricular size and function.

• Atrial size and interatrial septum.

• Withdraw TEE probe "and turn leftward" for visualization of appendage.

• Mitral valve (MV) scallops: A1, P1 (see Chapter 14, Figs. 1,2, 36).

• Color flow Doppler to tricuspid valve.

• Pulsed-wave Doppler to MV to assess LV inflow.

ME mitral commissural 80°(G): Figs. 11 and 12.

• Anterolateral and posteromedial MV commissures.

• Lateral (P1), middle (A2), and medial (P3) scallops of both anterior (A) and posterior (P) leaflets (see Chapter 14, Figs. 1, 2, and 36).

• LV function, inferior and anterior walls.

• Continuous-wave (CW) Doppler to LV (A, S, D waves).

• AV and proximal ascending aorta.

• LV anterior septum and posterior wall.

• Color flow Doppler to mitral and AVs.

ORDER OF EXAMINATION: STAGE 2

ME level: with angle approx 90°, sweep R to L.

• ME right ventricular inflow-outflow 80° (M): Figs. 17 and 18 (please see companion DVD for corresponding video for Fig. 18).

• Withdraw: ME ascending aortic long axis 100° (P): Figs. 21 and 22 (please see companion DVD for corresponding video for Fig. 22).

• Advance: ME aortic long axis 130° (I): Figs. 23 and 24 (please see companion DVD for corresponding video for Fig. 24).

ME Right ventricular inflow-outflow (M): Figs. 17 and 18 (please see companion DVD for corresponding video for Fig. 18).

• Tricuspid valve, right ventricular outflow, pulmonic valve.

• Color flow Doppler to tricuspid and pulmonic valves.

• CW Doppler for tricuspid regurgitation.

• Check for patent foramen ovale using color flow Doppler.

• Check for secundum and sinus venous atrial septal defects.

• Superior vena cava, inferior vena cava, eustachian valve (Chiari) remnants.

ME Ascending aortic long axis view (P): Figs. 21 and 22 (please see companion DVD for corresponding video for Fig. 22).

• Evaluate for aortic atheroma, dissection, or thrombus.

• Right pulmonary artery as it crosses behind the ascending aorta on its way to the right lung.

ME aortic valve long axis (I): Figs. 23 and 24 (please see companion DVD for corresponding video for Fig. 24).

ORDER OF EXAMINATION: STAGE 3

• ME ascending aortic short axis 20° (O): Figs. 25 and 26 (please see companion DVD for corresponding video for Fig. 26).

• Withdraw: ME AV short axis 60° (H): Figs. 27 and 28 (please see companion DVD for corresponding video for Fig. 28).

• UE aortic arch long axis 0° (S): Figs. 29 and 30 (please see companion DVD for corresponding video for Fig. 30).

• UE aortic arch short axis 90° (T): Fig. 31 (please see companion DVD for corresponding video).

• Turn left, advance: descending aortic long axis 90° (R): Figs. 32 and 33 (please see companion DVD for corresponding video for Fig. 33).

• Descending aortic short axis 0° (Q): Figs. 34 and 35 (please see companion DVD for corresponding video for Fig. 35).

ME ascending aortic short-axis view (O): Figs. 25 and 26 (please see companion DVD for corresponding video for Fig. 26).

• Evaluate aorta for atheromatous change, aortic dissection, or thrombus.

• Pulmonary artery bifurcation.

ME aortic valve short axis (H): Figs. 27 and 28 (please see companion DVD for corresponding video for Fig. 28).

• Evaluate AV and aortic cusps.

• Evaluate coronary arteries and flow: left main and right coronary artery.

UE aortic arch long axis (S): Figs. 29 and 30 (please see companion DVD for corresponding video for Fig. 30).

• Evaluate aortic arch for atheromatous change, dissection, or thrombus.

UE aortic arch short axis (T): Fig. 31 (please see companion DVD for corresponding video).

• Evaluate aortic arch atheromatous change, dissection, thrombus.

• Evaluate origin of great vessel(s) for atheroma or dissection.

Descending aortic long axis (R): Figs. 32 and 33 (please see companion DVD for corresponding video for Fig. 33).

• Evaluate aorta for atheromatous change, dissection, or thrombus.

Descending aortic short axis (Q): Figs. 34 and 35 (please see companion DVD for corresponding video for Fig. 35).

• Evaluate aorta for atheromatous change, dissection, or thrombus.

ORDER OF EXAMINATION: STAGE 4

Advance to stomach, anteflex.

• Transgastric midshort axis 0° (D): Figs. 36 and 37 (please see companion DVD for corresponding video for Fig. 37).

• Withdraw slightly: transgastric basal short axis 0° (F): Figs. 38 and 39 (please see companion DVD for corresponding video for Fig. 39).

• Transgastric two-chamber 90° (E): Figs. 40 and 41 (please see companion DVD for corresponding video for Fig. 41).

• 90-120°: transgastric long axis 120° (J): Figs. 42 and 43.

• Turn right: transgastric right ventricular inflow 120° (N): Figs. 44 and 45 (please see companion DVD for corresponding video for Fig. 45).

• Advance, anteflex: deep transgastric long axis 0° (K): Figs. 46 and 47 (please see companion DVD for corresponding video for Fig. 46).

Transgastric mid-short axis (D): Figs. 36 and 37 (please see companion DVD for corresponding video for Fig. 37).

• Assess wall motion and thickening.

• Assess left and right ventricular size, wall thickness, and function.

Transgastric basal short axis (F): Figs. 38 and 39 (please see companion DVD for corresponding video-for Fig. 39).

• Assess MV function and anterior and posterior mitral leaflets.

Transgastric two chamber (E): Figs. 40 and 41 (please see companion DVD for corresponding video for Fig. 41).

• Assess anterior and inferior LV wall.

Transgastric long axis (J): Figs. 42 and 43.

• CW to the AV with velocity time integral.

Transgastric right ventricular inflow (N): Figs. 44 and 45 (please see companion DVD for corresponding video for Fig. 45).

• Multipla'ne at 100-120° when indicated.

K. deep transgastric long axis: Figs. 46 and 47 (please see companion DVD for corresponding video for Fig. 46).

• Aortic flow, including CW Doppler to AV with AV velocity time integral.

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